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There’s more powerful confirmation this morning that rural North Carolinians and rural Americans are voting against their own interests and those of their children to the extent that they are supporting politicians who seek to wreck public health structures like Medicaid. According to a new report produced jointly by the Georgetown Center for Children and Families and the the NC Rural Health Research Program at UNC, Medicaid is an incredibly vital lifeline for rural children, families and communities. Here are the key findings in “Medicaid in Small Towns and Rural America: A Lifeline for Children, Families and Communities”:

Medicaid covers a larger share of children and families in small towns and rural areas than in large metropolitan areas. In 2014-2015, Medicaid provided health coverage for 45 percent of children and 16 percent of adults in small towns and rural areas, compared to 38 percent and 15 percent, respectively, in metropolitan areas. In nearly all states, a larger share of children and adults living in small towns and rural areas relies on Medicaid than those in metropolitan areas—and is more likely to be affected by increases or decreases in services.

The Affordable Care Act’s Medicaid expansion is having a disproportionately positive impact on small towns and rural areas. The rate of uninsured adults in expansion states decreased 11 percentage points in the small towns and rural areas of these states between 2008-2009 and 2014-2015. This is larger than the decrease in metropolitan areas of expansion states (9 percentage points) and larger than the decrease in small towns and rural areas in states that did not accept the expansion (6 percentage points).

The rate of uninsured children in small towns and rural areas declined in the vast majority of states (43 out of 46 states) during the time period examined. The national rate of uninsured children in small towns and rural areas decreased by 3 percentage points. Five states (Colorado, Nevada, New Mexico, Oregon, and South Carolina) saw very large declines of at least 8 percentage points between 2008-2009 and 2014-2015. Three of these states (Nevada, Oregon and South Carolina) had the largest percentage point increases in children’s Medicaid coverage among small towns and rural areas.

“One of the reasons that rural areas and small towns rely on Medicaid more is because the overall poverty rates are higher and the types of jobs there, such as agriculture or small businesses, are less likely to offer insurance.

The declining number of uninsured children and adults found in our research, especially in small towns and rural areas, is striking. It means that more people are protected from financial risk when they need health care services and that children and adults are able to access the primary and preventive care they need. Research is clear that children who are insured by Medicaid have better health outcomes, do better in school, and ultimately have better economic prospects.

And while the impact of the ACA’s Medicaid expansion is very clear for adults, for children this is not just an ACA story. The improvements achieved for children are the result of years of bipartisan effort through both Medicaid and CHIP to reduce the number of uninsured kids. The good news is that rural areas and small towns have not been left out from this national success story.

The bad news of course is that this success is threatened by the massive cuts to Medicaid and CHIP that are now under consideration by Congress as I have blogged about elsewhere. As the data in the report makes clear, small towns and rural areas would be especially hard hit by cuts to Medicaid.”